Marta Crespo1, Auxiliadora Mazuecos2, Emilio Rodrigo3, Eva Gavela4, Florentino Villanego2, Emilio Sánchez-Alvarez5, Esther González-Monte6, Carlos Jiménez-Martín7, Edoardo Melilli8, Fritz Diekman9, Sofía Zárraga10, Domingo Hernández11, Julio Pascual1. 1. Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain. 2. Department of Nephrology, Hospital Puerta del Mar, Cádiz, Spain. 3. Department of Nephrology, Hospital Marqués de Valdecilla, Santander, Spain. 4. Department of Nephrology, Hospital Doctor Peset, Valencia, Spain. 5. Department of Nephrology, Hospital de Cabueñes, Gijón, Spain. 6. Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain. 7. Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain. 8. Department of Nephrology, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. 9. Department of Nephrology and Kidney Transplantation, Hospital Clinic, Barcelona, Spain. 10. Department of Nephrology, Hospital de Cruces, Bilbao, Spain. 11. Department of Nephrology, Hospital Regional Universitario Carlos Haya, University of Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain.
Abstract
BACKGROUND: Coronavirus infectious disease 2019 (COVID-19) pandemic has posed at risk the kidney transplant (KT) population. We describe clinical pictures, risk factors for death, and chances to recovery in a large cohort of KT recipients with COVID-19. METHODS: Inclusion in a Spanish prospectively filled registry was allowed for KT cases with confirmed COVID-19. Outcomes were assessed as in-hospital mortality or recovery. RESULTS: The study population comprised of 414 patients. Fever, respiratory symptoms, and dyspnea were the most frequent COVID-19-related symptoms, and 81.4% of them had pneumonia. More than one-third of patients showed digestive symptoms at diagnosis, combinations of nausea, vomiting, and diarrhea. Most patients were hospitalized, 12.1% in intensive care units, and 17.6% needed ventilator support. Treatment for COVID-19 included frequently hydroxychloroquine, azithromycin, high-dose steroids, lopinavir/ritonavir, and tocilizumab. After a mean follow-up of 44 days, the fatality rate was 26.3%. Pneumonia without gastrointestinal symptoms was associated with a 36.3% mortality (respiratory phenotype), and gastrointestinal symptoms without pneumonia with a 5.3% mortality (gastrointestinal phenotype). The mixed pneumonia and gastrointestinal phenotype showed an intermediate mortality of 19.5% (mixed phenotype). Multivariate Cox regression analysis showed that age and pneumonia were independently associated with death, whereas the gastrointestinal phenotype was associated with recovery. CONCLUSIONS: COVID-19 is frequent among the KT population. Advanced age and pneumonia are the main clinical features associated with a high-mortality rate. Gastrointestinal disease is associated with a more benign course and lower mortality.
BACKGROUND: Coronavirus infectious disease 2019 (COVID-19) pandemic has posed at risk the kidney transplant (KT) population. We describe clinical pictures, risk factors for death, and chances to recovery in a large cohort of KT recipients with COVID-19. METHODS: Inclusion in a Spanish prospectively filled registry was allowed for KT cases with confirmed COVID-19. Outcomes were assessed as in-hospital mortality or recovery. RESULTS: The study population comprised of 414 patients. Fever, respiratory symptoms, and dyspnea were the most frequent COVID-19-related symptoms, and 81.4% of them had pneumonia. More than one-third of patients showed digestive symptoms at diagnosis, combinations of nausea, vomiting, and diarrhea. Most patients were hospitalized, 12.1% in intensive care units, and 17.6% needed ventilator support. Treatment for COVID-19 included frequently hydroxychloroquine, azithromycin, high-dose steroids, lopinavir/ritonavir, and tocilizumab. After a mean follow-up of 44 days, the fatality rate was 26.3%. Pneumonia without gastrointestinal symptoms was associated with a 36.3% mortality (respiratory phenotype), and gastrointestinal symptoms without pneumonia with a 5.3% mortality (gastrointestinal phenotype). The mixed pneumonia and gastrointestinal phenotype showed an intermediate mortality of 19.5% (mixed phenotype). Multivariate Cox regression analysis showed that age and pneumonia were independently associated with death, whereas the gastrointestinal phenotype was associated with recovery. CONCLUSIONS:COVID-19 is frequent among the KT population. Advanced age and pneumonia are the main clinical features associated with a high-mortality rate. Gastrointestinal disease is associated with a more benign course and lower mortality.
Authors: Florentino Villanego; Auxiliadora Mazuecos; Isabel M Pérez-Flores; Francesc Moreso; Amado Andrés; Carlos Jiménez-Martín; María Molina; Cristina Canal; Luis A Sánchez-Cámara; Sofía Zárraga; María Del Carmen Ruiz-Fuentes; María José Aladrén; Edoardo Melilli; Verónica López; Emilio Sánchez-Álvarez; Marta Crespo; Julio Pascual Journal: Am J Transplant Date: 2021-04-12 Impact factor: 8.086
Authors: Raphaël Duivenvoorden; Priya Vart; Marlies Noordzij; Augusto C Soares Dos Santos; Alex B Zulkarnaev; Casper F M Franssen; Dirk Kuypers; Erol Demir; Hormat Rahimzadeh; Julia Kerschbaum; Kitty J Jager; Kultigin Turkmen; Marc H Hemmelder; Marcel Schouten; María Luisa Rodríguez-Ferrero; Marta Crespo; Ron T Gansevoort; Luuk B Hilbrands Journal: Transplantation Date: 2022-04-26 Impact factor: 5.385
Authors: Florentino Villanego; Luis Alberto Vigara; Julia Torrado; Javier Naranjo; Ana María García; Teresa García; Auxiliadora Mazuecos Journal: Nefrologia (Engl Ed) Date: 2021-01-09
Authors: Luke Benvenuto; Mark E Snyder; Meghan Aversa; Shreena Patel; Joseph Costa; Lori Shah; Hilary Robbins; Frank D'Ovidio; Joshua Sonett; Bryan P Stanifer; Philippe Lemaitre; Selim Arcasoy; Michaela R Anderson Journal: Transplantation Date: 2021-04-01 Impact factor: 5.385
Authors: Chia Wei Teoh; Marie-Michele Gaudreault-Tremblay; Tom D Blydt-Hansen; Aviva Goldberg; Steven Arora; Janusz Feber; Valerie Langlois; Michelle Ruhl; Veronique Phan; Catherine Morgan; Philip Acott; Lorraine Hamiwka Journal: Can J Kidney Health Dis Date: 2020-11-13